Leveraging Business Process Management capabilities to improve Provider Relations


The most common business for insurance companies today are patient related matters concerning membership, benefits, pre-authorization and claim payment, maintenance-related issues and the long duration of case management. Extensive documentation associated with all this business and often manual, paper-based business processes. This causes processing delays, inefficiencies and inaccuracies and increased operating expenses.

Manual business processes prevents universal access to related important documents, prevent the effectiveness of first-call issue resolution. In addition, the business is regulatory compliance mandates can not be managed like organization records.

Insurers need solutions that enable them to accelerate the hand business by supporting timely and consistent workload management. Business process automation solutions can reduce costs and increase efficiency and achieve high levels of first call resolution by providing employees with the information needed to respond immediately to provider inquiries. In addition, insurance companies will also be able to meet the increasingly stringent and comprehensive regulations and requirements to control the organization of records.

With this type of software, trading with paper, fax, email or through self-service portals are taken, recorded and stored in the content management repository. Furnish transactions are managed, offering a secure interface for documents, host system data and complete the task. Configurable business rules Automate distribution, creating and giving of electronic parts work to the appropriate person in the next step in the business process. If additional data is received later, the solution automatically matches it with the current processing.

solutions extensive case management capabilities also noted staff credentialing single electronic case containing all related documents, extensive data from administrative and other business systems together with project guidance and process management features. This not only eliminates manual discuss the meeting, searching and sorting, it also simplifies judgments by providing guidance to all relevant information and strengthens the decision-making data in an easy to use interface specific to each step of the credentialing process. In addition, process management features automate credentialing project, create task reminders and form must follow function.

When available documents shall be in accordance with regulations, such as Sarbanes-Oxley, the application raises records management capabilities. The solution provides efficient capabilities for immediate answer routine supply request and also solve gone requests rapidly exactly. Finally, there is paper driven process more efficient material and process automation.

These interfaces improve productivity and accuracy by allowing provider relations representative to work on a single, consolidated view. This makes them easy access to all the information available to process the insurance business, as well as the ability to view tasks in the order they will be met.


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